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Initiative helped improve strategies to prevent hospital readmissions
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Participation in the Hospital to Home Quality Improvement Initiative has helped improve strategies to prevent hospital readmissions, including tracking discharged patients, partnerships with local hospitals and more, according to a recent report.
The initiative is led by the American College of Cardiology and the Institute for Healthcare Improvement. The nationwide quality improvement campaign was developed to reduce CV-related hospital readmissions and improve the transition from inpatient to outpatient status for patients who are hospitalized with CVD, according to the Hospital to Home (H2H) Quality Improvement Initiative website.
In a research letter published in JAMA Internal Medicine, Elizabeth H. Bradley, PhD, of the department of health policy and management at Yale School of Public Health, and colleagues evaluated the change in use of recommended strategies for reducing unplanned hospital admissions between 2010 and 2012 among hospitals participating in the H2H Quality Improvement Initiative. The study included 437 hospitals that completed a Web-based survey at baseline and 12 to 18 months later. Thirty-five percent were teaching hospitals, 30% had at least 400 beds, 73% were part of multi-hospital systems, 22% were for-profit hospitals and 5% were located in rural areas.
On follow-up, significantly more initiative hospitals reported partnering with other local hospitals to reduce readmissions (30.7% vs. 22.9% at baseline; P=.002). More hospitals also reported discharging patients with a follow-up appointment already scheduled (61.1% at follow-up vs. 52.4% at baseline; P=.005) and tracking discharged patients with a follow-up appointment scheduled within the subsequent week (43% at follow-up vs. 32.2% at baseline; P<.001). The initiative also was associated with more tracking of patients readmitted to different hospitals (19% at follow-up vs. 12% at baseline; P=.001).
The researchers also observed significant increases in the number of hospitals that reported formal estimation of risk for readmission (34.6% at follow-up vs. 22.5% at baseline), use of electronic forms to reconcile medications (81% at follow-up vs. 72.8% at baseline) and use of “teach-back” techniques wherein patients are asked to restate instructions or decisions about treatment, in their own words, to health care professionals (80.8% at follow-up vs. 68.9% at baseline; P<.001 for all). Participating hospitals also were more likely at follow-up to offer action plans to patients with HF upon discharge (60% vs. 52.2% at baseline; P=.005) and contact patients to offer education and assess their needs after discharge (71.4% vs. 62.9% at baseline; P<.001).
Strategies not implemented more frequently on follow-up assessment included informing outpatient physicians about patient discharges within 48 hours; follow-up on test results obtained postdischarge; sending discharge summaries to primary care physicians; and conducting nurse-to-nurse reports before discharging patients to nursing homes.
The observed results did not vary significantly based on number of beds, teaching hospital vs. multi-hospital affiliation, census region or type of ownership.
“Despite financial incentives for hospitals to reduce readmission rates, many hospitals are not implementing recommended strategies that have been shown to be associated with lower hospital risk-standardized readmission rates,” the researchers wrote.
“Our work provides national data among a group of hospitals most likely to engage in improvement activities and may partially explain the slow rate of improvement in readmission rates nationally. More consistently implemented strategies to promote safe transitions from hospital to home are likely critical for reducing readmission rates in the years ahead,” they wrote.
The H2H Quality Improvement Initiative was launched in 2009.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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